Drugs Requiring Approval

  • On drugs required for certain medical conditions, you may need to get prior approval before the prescription is covered. Read more about situations where prior approval is required.

    Drug Reviews

    Search your drug in our Rx Search tool. Some drugs may require more information from your provider before they can be prescribed and covered by the plan. Certain medications may show “Excluded” unless you are logged in to Premera’s secure website. Call Partner Services at 877-728-9020 should you require immediate clarification.

  • Some drugs are part of the Premera Pharmacy Prior Authorization Program. If you take medications for certain conditions – such as migraines, diabetes, high blood pressure, or asthma – you may need to meet certain requirements before your prescription is covered.

    Go to the Pharmacy Prior Authorization Drugs tab to see if your drug requires this type of pre-service review.

    How the program works

    When you go to the pharmacy to fill your prescription, your prescription drug therapy is checked to see if it meets recommended guidelines:

    • If the drug meets these guidelines, your prescription is filled without interruption.
    • If the drug does not meet the guidelines, your prescription will not be filled until it has been reviewed.

    Review process

    You or your pharmacy can call your doctor to notify him or her that a Pharmacy Prior Authorization is needed for your drug. Your doctor will need to contact our Pharmacy Services Center to request a review.

    Once we receive your doctor’s information, our review process will take one to two business days. Then we’ll send you a letter confirming the decision made about your prescription coverage. We’ll also fax the decision to your doctor.

    • If your prescription is approved, then it will be covered by your prescription benefits, and can be filled at your pharmacy.
    • If your prescription is not approved, then it will not be covered by your prescription benefits and you should talk to your doctor about an alternate medicine.

    Type in the name of the drug for details about prior authorization criteria, and medical policies.

    Note: This list shows drugs that require pharmacy prior authorization that are common to all plans.

    For drug review requirements specific to your plan, log in and use My Rx Choices to find out if your drug requires pharmacy prior authorization.

     

     

    Universal Pharmacy Prior Authorization Form 

    *This form can be used to submit all types of requests for medical necessity.